10 results on '"Petrowsky, H."'
Search Results
2. Liver transplantation in recipients receiving renal replacement therapy: outcomes analysis and the role of intraoperative hemodialysis.
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Agopian, VG, Dhillon, A, Baber, J, Kaldas, FM, Zarrinpar, A, Farmer, DG, Petrowsky, H, Xia, V, Honda, H, Gornbein, J, Hiatt, JR, and Busuttil, RW
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Humans ,Kidney Diseases ,Postoperative Complications ,Prognosis ,Intraoperative Care ,Renal Dialysis ,Liver Transplantation ,Survival Rate ,Retrospective Studies ,Follow-Up Studies ,Prospective Studies ,Recovery of Function ,Graft Survival ,Adult ,Middle Aged ,Female ,Male ,End Stage Liver Disease ,Hemodialysis ,liver transplantation ,outcomes ,pretransplant renal failure ,renal disease in liver transplantation ,Surgery ,Medical and Health Sciences - Abstract
The Model for End-Stage Liver Disease (MELD) system has dramatically increased the number of recipients requiring pretransplant renal replacement therapy (RRT) prior to liver transplantation (LT). Factors affecting post-LT outcomes and the need for intraoperative RRT (IORRT) were analyzed in 500 consecutive recipients receiving pretransplant RRT, including comparisons among recipients not receiving IORRT (No-IORRT, n = 401), receiving planned IORRT (Pl-IORRT, n = 70), and receiving emergent, unplanned RRT after LT initiation (Em-IORRT, n = 29). Despite a median MELD of 39, overall 30-day, 1-, 3- and 5-year survivals were 93%, 75%, 68% and 65%, respectively. Em-IORRT recipients had significantly more intraoperative complications (arrhythmias, postreperfusion syndrome, coagulopathy) compared with both No-IORRT and Pl-IORRT and greater 30-day graft loss (28% vs. 10%, p = 0.004) and need for retransplantation (24% vs. 10%, p = 0.099) compared with No-IORRT. A risk score based on multivariate predictors of IORRT accurately identified recipients with chronic (sensitivity 84%, specificity 72%, concordance-statistic [c-statistic] 0.829) and acute (sensitivity 93%, specificity 61%, c-statistic 0.776) liver failure requiring IORRT. In this largest experience of LT in recipients receiving RRT, we report excellent survival and propose a practical model that accurately identifies recipients who may benefit from IORRT. For this select group, timely initiation of IORRT reduces intraoperative complications and improves posttransplant outcomes.
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- 2014
3. Enterothorax After Hepatic Surgery: A Single-Center Experience.
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Manzini, G., Kuemmerli, C., Reiner, C. S., Petrowsky, H., and Gutschow, C. A.
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POSTOPERATIVE pain ,SURGICAL emergencies ,HEPATIC veins ,LARGE intestine ,SURGERY ,LIVER transplantation ,HEPATECTOMY - Abstract
Background: Enterothorax (ET) is a rare complication after hepatic surgery. The literature in this field is limited and mainly based on case reports. The aim of this study was to review our department's experience.Patients and methods: We retrospectively analyzed 602 patients who underwent hepatic resection between November 2008 and December 2016. Major hepatic surgery (n = 321) was defined as right or extended right hepatectomy (n = 227), left or extended left hepatectomy (n = 63), trisegmentectomy (n = 13), and living donor liver transplantation (n = 18). ET cases were identified by analyzing clinical courses and radiological imaging.Results: ET was observed in five out of 602 patients (0.8%). All patients developed the complication after major hepatic surgery (five out of 321, 1.6%). ET exclusively occurred after right (n = 3) or extended right hepatectomy (n = 2). Median time to diagnosis was 22 months. Radiological imaging showed herniation of small (n = 2), large bowel (n = 2), or omental fat (n = 1) with a median diaphragmatic defect of 3.9 cm. Two patients presented with acute incarceration and underwent emergency surgery, one patient reported recurrent pain and underwent elective repair, and two patients refused surgery. Follow-up imaging in two operated patients showed no recurrence of ET after 36 and 8 months.Conclusions: Patients after right hepatectomy have a substantial risk of ET. Acute right upper quadrant pain and/or dyspnea after hepatectomy should be investigated with adequate radiological imaging. Elective surgical repair of ET is recommended to avoid emergency surgery in case of incarceration. [ABSTRACT FROM AUTHOR]
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- 2019
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4. Current Surgical Management of Hilar and Intrahepatic Cholangiocarcinoma: The Role of Resection and Orthotopic Liver Transplantation
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Petrowsky, H. and Hong, J.C.
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INTRAHEPATIC bile ducts , *CHOLANGIOCARCINOMA , *CANCER diagnosis , *CANCER-related mortality , *LIVER transplantation , *HEPATECTOMY , *HEPATIC artery , *PORTAL vein , *PALLIATIVE treatment , *SURGERY - Abstract
Abstract: Cholangiocarcinoma (CCA) is a rare but devastating malignancy that presents late, is notoriously difficult to diagnose, and is associated with a high mortality. Surgical resection is the only chance for cure or long-term survival. The treatment of CCA has remained challenging because of the lack of effective adjuvant therapy, aggressive nature of the disease, and critical location of the tumor in close proximity to vital structures such as the hepatic artery and the portal vein. Moreover, the operative approach is dictated by the location of the tumor and the presence of underlying liver disease. During the past 4 decades, the operative management of CCA has evolved from a treatment modality that primarily aimed at palliation to curative intent with an aggressive surgical approach to R0 resection and total hepatectomy followed by orthotopic liver transplantation. [Copyright &y& Elsevier]
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- 2009
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5. Neoadjuvant Therapy for Resectable Pancreatic Cancer
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Ralph Fritsch, Pierre-Alain Clavien, Mickael Lesurtel, Francesco Minni, Michelle L. DeOliveira, Saskia Hussung, Thomas J. Meyer, Christian E. Oberkofler, Thomas Brunner, Bernhard C. Pestalozzi, Riccardo Casadei, Susanne Merkel, Christiane Bruns, Carlo Ingaldi, Sarah R. Haile, Carla Serra, Claudio Ricci, Stefan Heinrich, Wolf O. Bechstein, Robert Grützmann, Alessandra Guido, Henriette Golcher, Henrik Petrowsky, Mariacristina Di Marco, Milo A. Puhan, Dominique Lisa Birrer, Rainer Fietkau, Birrer D.L., Golcher H., Casadei R., Haile S.R., Fritsch R., Hussung S., Brunner T.B., Fietkau R., Meyer T., Grutzmann R., Merkel S., Ricci C., Ingaldi C., Di Marco M., Guido A., Serra C., Minni F., Pestalozzi B., Petrowsky H., Deoliveira M., Bechstein W.O., Bruns C.J., Oberkofler C.E., Puhan M., Lesurtel M., Heinrich S., and Clavien P.-A.
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Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,Pancreatic resection ,Disease-Free Survival ,Pancreaticoduodenectomy ,law.invention ,Pancreatectomy ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Adjuvant therapy ,Clinical endpoint ,Humans ,Neoadjuvant therapy ,Randomized Controlled Trials as Topic ,business.industry ,Hazard ratio ,Neoadjuvant chemotherapy/radiochemotherapy ,Pancreatic Neoplasm ,Resectable pancreatic cancer ,Combined Modality Therapy ,Neoadjuvant Therapy ,Confidence interval ,Pancreatic Neoplasms ,Regimen ,Surgery ,business ,Complication ,Human - Abstract
Objective The aim of this study was to pool data from randomized controlled trials (RCT) limited to resectable pancreatic ductal adenocarcinoma (PDAC) to determine whether a neoadjuvant therapy impacts on disease-free survival (DFS) and surgical outcome. Summary background data Few underpowered studies have suggested benefits from neoadjuvant chemo (± radiation) for strictly resectable PDAC without offering conclusive recommendations. Methods Three RCTs were identified comparing neoadjuvant chemo (± radio) therapy vs. upfront surgery followed by adjuvant therapy in all cases. Data were pooled targeting DFS as primary endpoint, whereas overall survival (OS), postoperative morbidity, and mortality were investigated as secondary endpoints. Survival endpoints DFS and OS were compared using Cox proportional hazards regression with study-specific baseline hazards. Results A total of 130 patients were randomized (56 in the neoadjuvant and 74 in the control group). DFS was significantly longer in the neoadjuvant treatment group compared to surgery only [hazard ratio (HR) 0.6, 95% confidence interval (CI) 0.4-0.9] (P = 0.01). Furthermore, DFS for the subgroup of R0 resections was similarly longer in the neoadjuvant treated group (HR 0.6, 95% CI 0.35-0.9, P = 0.045). Although postoperative complications (Comprehensive Complication Index, CCI®) occurred less frequently (P = 0.008), patients after neoadjuvant therapy experienced a higher toxicity, but without negative impact on oncological or surgical outcome parameters. Conclusion Neoadjuvant therapy can be offered as an acceptable standard of care for patients with purely resectable PDAC. Future research with the advances of precision oncology should now focus on the definition of the optimal regimen.
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- 2021
6. Safety and Efficacy of Robotic vs Open Liver Resection for Hepatocellular Carcinoma
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Fabrizio, Di Benedetto, Paolo, Magistri, Stefano, Di Sandro, Carlo, Sposito, Christian, Oberkofler, Ellie, Brandon, Benjamin, Samstein, Cristiano, Guidetti, Alexandros, Papageorgiou, Samuele, Frassoni, Vincenzo, Bagnardi, Pierre-Alain, Clavien, Davide, Citterio, Tomoaki, Kato, Henrik, Petrowsky, Karim J, Halazun, Vincenzo, Mazzaferro, Maria, Flores, Di Benedetto, F, Magistri, P, Di Sandro, S, Sposito, C, Oberkofler, C, Brandon, E, Samstein, B, Guidetti, C, Papageorgiou, A, Frassoni, S, Bagnardi, V, Clavien, P, Citterio, D, Kato, T, Petrowsky, H, Halazun, K, and Mazzaferro, V
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Settore MED/18 - Chirurgia Generale ,Surgery ,Hepatocellular Carcinoma - Abstract
ImportanceLong-term oncologic outcomes of robotic surgery remain a hotly debated topic in surgical oncology, but sparse data have been published thus far.ObjectiveTo analyze short- and long-term outcomes of robotic liver resection (RLR) for hepatocellular carcinoma (HCC) from Western high-volume centers to assess the safety, reproducibility, and oncologic efficacy of this technique.Design, Setting, and ParticipantsThis cohort study evaluated the outcomes of patients receiving RLR vs open liver resection (OLR) for HCC between 2010 and 2020 in 5 high-volume centers. After 1:1 propensity score matching, a group of patients who underwent RLR was compared with a validation cohort of OLR patients from a high-volume center that did not perform RLR.Main Outcomes and MeasuresA retrospective analysis was performed of prospectively maintained databases at 2 European and 2 US institutions of patients who underwent RLR for HCC between January 1, 2010, and September 30, 2020. The main outcomes were safety and feasibility of RLR for HCC and its oncologic outcomes compared with a European OLR validation cohort. A 2-sided P ResultsThe study included 398 patients (RLR group: 125 men, 33 women, median [IQR] age, 66 [58-71] years; OLR group: 315 men, 83 women; median [IQR] age, 70 [64-74] years), and 106 RLR patients were compared with 106 OLR patients after propensity score matching. The RLR patients had a significantly longer operative time (median [IQR], 295 [190-370] minutes vs 200 [165-255] minutes, including docking; P P P = .002). Incidence of posthepatectomy liver failure was significantly lower in the RLR group (8 [7.5%] vs 30 [28.3%]; P = .001), with no cases of grade C failure. The 90-day overall survival rate was comparable between the 2 groups (RLR, 99.1% [95% CI, 93.5%-99.9%]; OLR, 97.1% [95% CI, 91.3%-99.1%]), as was the cumulative incidence of death related to tumor recurrence (RLR, 8.8% [95% CI, 3.1%-18.3%]; OLR, 10.2% [95% CI, 4.9%-17.7%]).Conclusions and RelevanceThis study represents the largest Western experience to date of full RLR for HCC. Compared with OLR, RLR performed in tertiary centers represents a safe treatment strategy for patients with HCC and those with compromised liver function while achieving oncologic efficacy.
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- 2023
7. First Long-term Oncologic Results of the ALPPS Procedure in a Large Cohort of Patients With Colorectal Liver Metastases
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Carlos Castro-Benitez, Roberto Brusadin, Jun Li, Martin Teutsch, Luca Aldrighetti, Patryk Kambakamba, Jan Bednarsch, Arianeb Mehrabi, Mauro E Tun Abraham, Marcus N. Scherer, François-René Pruvot, Roberto Hernandez-Alejandro, Eduardo Fernandes, Christoph Kuemmerli, Emir Hoti, Onur Elvan Kirimker, Federico Tomassini, Tim Reese, Francesca Ratti, Pim B. Olthof, Stéphanie Truant, Ivan Capobianco, Roberto Troisi, Mohammad-Hossein Fard-Aghaie, Henrik Petrowsky, Victor Lopez-Lopez, Philipp Kron, Pierre-Alain Clavien, Hans J. Schlitt, Ricardo Robles-Campos, Omid Ghamarnejad, Silvio Nadalin, Thomas M. van Gulik, René Adam, Deniz Balci, Marcel Autran C. Machado, Peter Lodge, Ralph Fritsch, Dimitri A. Raptis, Sergey Voskanyan, Georg Lurje, Karl J. Oldhafer, Massimo Malagó, Michael Linecker, Eduardo de Santibañes, Victoria Ardiles, Petrowsky, H., Linecker, M., Raptis, D. A., Kuemmerli, C., Fritsch, R., Kirimker, O. E., Balci, D., Ratti, F., Aldrighetti, L., Voskanyan, S., Tomassini, F., Troisi, R., Bednarsch, J., Lurje, G., Fard-Aghaie, M. -H., Reese, T., Oldhafer, K. J., Ghamarnejad, O., Mehrabi, A., Abraham, M. E. T., Truant, S., Pruvot, F. -R., Hoti, E., Kambakamba, P., Capobianco, I., Nadalin, S., Fernandes, E. S. M., Kron, P., Lodge, P., Olthof, P. B., van Gulik, T., Castro-Benitez, C., Adam, R., Machado, M. A., Teutsch, M., Li, J., Scherer, M. N., Schlitt, H. J., Ardiles, V., de Santibanes, E., Brusadin, R., Lopez-Lopez, V., Robles-Campos, R., Malago, M., Hernandez-Alejandro, R., and Clavien, P. -A.
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Male ,medicine.medical_specialty ,Multivariate analysis ,medicine.medical_treatment ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,law ,Risk Factors ,medicine ,Hepatectomy ,Humans ,Registries ,Survival analysis ,Aged ,business.industry ,Liver Neoplasms ,Perioperative ,Middle Aged ,Survival Analysis ,Confidence interval ,Surgery ,Response Evaluation Criteria in Solid Tumors ,030220 oncology & carcinogenesis ,Cohort ,030211 gastroenterology & hepatology ,Female ,business ,Colorectal Neoplasms - Abstract
Objectives: To analyze long-term oncological outcome along with prognostic risk factors in a large cohort of patients with colorectal liver metastases (CRLM) undergoing ALPPS. Background: ALPPS is a two-stage hepatectomy variant that increases resection rates and R0 resection rates in patients with primarily unresectable CRLM as evidenced in a recent randomized controlled trial. Long-term oncologic results, however, are lacking. Methods: Cases in- and outside the International ALPPS Registry were collected and completed by direct contacts to ALPPS centers to secure a comprehensive cohort. Overall, cancer-specific (CSS), and recurrence-free (RFS) survivals were analyzed along with independent risk factors using Cox-regression analysis. Results: The cohort included 510 patients from 22 ALPPS centers over a 10-year period. Ninety-day mortality was 4.9% and median overall survival, CSS, and RFS were 39, 42, and 15 months, respectively. The median follow-up time was 38 months (95% confidence interval 32-43 months). Multivariate analysis identified tumor-characteristics (primary T4, right colon), biological features (K/N-RAS status), and response to chemotherapy (Response Evaluation Criteria in Solid Tumors) as independent predictors of CSS. Traditional factors such as size of metastases, uni versus bilobar involvement, and liver-first approach were not predictive. When hepatic recurrences after ALPPS was amenable to surgical/ablative treatment, median CSS was significantly superior compared to chemotherapy alone (56 vs 30 months, P < 0.001). Conclusions: This large cohort provides the first evidence that patients with primarily unresectable CRLM treated by ALPPS have not only low perioperative mortality, but achieve appealing long-term oncologic outcome especially those with favorable tumor biology and good response to chemotherapy.
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- 2020
8. ALPPS in neuroendocrine liver metastases not amenable for conventional resection – lessons learned from an interim analysis of the international ALPPS registry
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Ivan Kozyrin, Pierre-Alain Clavien, Jee K Low, Nadja Lehwald-Tywuschik, Francesca Ratti, Massimo Malagó, François-René Pruvot, Henrik Petrowsky, Emilio Vicente, Luca Aldrighetti, Wolfram T. Knoefel, Michail Pizanias, Patryk Kambakamba, Valentina Ferrri, Michael Linecker, Deniz Balci, Ashley K Clift, Ricardo Robles-Campos, Victoria Ardiles, Basant Mahadevappa, Andrea Frilling, Andreas Prachalias, Stéphanie Truant, Sergey Voskanyan, Dimitri A. Raptis, Eduardo de Santibañes, Karl J. Oldhafer, Gregor A. Stavrou, University of Zurich, Frilling, Andrea, Linecker, M., Kambakamba, P., Raptis, D. A., Malago, M., Ratti, F., Aldrighetti, L., Robles-Campos, R., Lehwald-Tywuschik, N., Knoefel, W. T., Balci, D., Ardiles, V., De Santibanes, E., Truant, S., Pruvot, F. -R., Stavrou, G. A., Oldhafer, K. J., Voskanyan, S., Mahadevappa, B., Kozyrin, I., Low, J. K., Ferrri, V., Vicente, E., Prachalias, A., Pizanias, M., Clift, A. K., Petrowsky, H., Clavien, P. -A., and Frilling, A.
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,610 Medicine & health ,030230 surgery ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Overall survival ,Hepatectomy ,Humans ,Medicine ,Effective treatment ,2715 Gastroenterology ,Registries ,Stage (cooking) ,Ligation ,Retrospective Studies ,R0 resection ,10217 Clinic for Visceral and Transplantation Surgery ,Hepatology ,Portal Vein ,business.industry ,Patient Selection ,Liver Neoplasms ,Gastroenterology ,Middle Aged ,Interim analysis ,Carcinoma, Neuroendocrine ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,2721 Hepatology ,business - Abstract
Background Surgery is the most effective treatment option for neuroendocrine liver metastases (NELM). This study investigated the role of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) as a novel strategy in treatment of NELM. Methods The International ALPPS Registry was reviewed to study patients who underwent ALPPS for NELM. Results From 2010 to 2017, 954 ALPPS procedures from 135 international centers were recorded in the International ALPPS Registry. Of them, 24 (2.5%) were performed for NELM. Twenty-one patients entered the final analysis. Overall grade ≥3b morbidity was 9% after stage 1 and 27% after stage 2. Ninety-day mortality was 5%. R0 resection was achieved in 19 cases (90%) at stage 2. Median follow-up was 28 (19–48) months. Median disease free survival (DFS) was 17.3 (95% CI: 7.1–27.4) months, 1-year and 2-year DFS was 73.2% and 41.8%, respectively. Median overall survival (OS) was not reached. One-year and 2-year OS was 95.2% and 95.2%, respectively. Conclusions ALPPS appears to be a suitable strategy for inclusion in the multimodal armamentarium of well-selected patients with neuroendocrine liver metastases. In light of the morbidity in this initial series and a high rate of disease-recurrence, the procedure should be taken with caution.
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- 2020
9. ALPPS for Locally Advanced Intrahepatic Cholangiocarcinoma: Did Aggressive Surgery Lead to the Oncological Benefit? An International Multi-center Study
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Ulf P. Neumann, J. Baumgart, Athanasios Petrou, Utz Settmacher, Sergey Voskanyan, M. Moustafa, Carlos Castro-Benitez, Roberto Montalti, Chao Liu, René Adam, Hans J. Schlitt, Ricardo Robles-Campos, Emilio Vicente, Yuji Soejima, E. Fasolo, Umberto Cillo, Jakub Kristek, Ivan Capobianco, Federico Tomassini, Roberto Hernandez-Alejandro, Asmus Heumann, Jakob R. Izbicki, Natascha Nuessler, Hauke Lang, Oszkár Hahn, Alexandros Kantas, Michael R. Schön, Roberto Troisi, Massimo Malagó, Silvio Nadalin, Georg Lurje, Stefan A. Topp, Michael Linecker, Enrico Gringeri, Francesca Ratti, Victoria Ardiles, Karl J. Oldhafer, Björn-Ole Stüben, Christiane Bruns, Luca Aldrighetti, Stefan M. Brunner, Henrik Petrowsky, Jun Li, Deniz Balci, Jens Rolinger, Andreas A. Schnitzbauer, Roger Wahba, Jan Bednarsch, Marco Vivarelli, Eduardo Fernandes, Pierre-Alain Clavien, Falk Rauchfuss, Jiri Fronek, Eduardo de Santibañes, Bergthor Björnsson, Li, J., Moustafa, M., Linecker, M., Lurje, G., Capobianco, I., Baumgart, J., Ratti, F., Rauchfuss, F., Balci, D., Fernandes, E., Montalti, R., Robles-Campos, R., Bjornsson, B., Topp, S. A., Fronek, J., Liu, C., Wahba, R., Bruns, C., Brunner, S. M., Schlitt, H. J., Heumann, A., Stuben, B. -O., Izbicki, J. R., Bednarsch, J., Gringeri, E., Fasolo, E., Rolinger, J., Kristek, J., Hernandez-Alejandro, R., Schnitzbauer, A., Nuessler, N., Schon, M. R., Voskanyan, S., Petrou, A. S., Hahn, O., Soejima, Y., Vicente, E., Castro-Benitez, C., Adam, R., Tomassini, F., Troisi, R. I., Kantas, A., Oldhafer, K. J., Ardiles, V., de Santibanes, E., Malago, M., Clavien, P. -A., Vivarelli, M., Settmacher, U., Aldrighetti, L., Neumann, U., Petrowsky, H., Cillo, U., Lang, H., and Nadalin, S.
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Adult ,Male ,medicine.medical_specialty ,International Cooperation ,Subgroup analysis ,Antineoplastic Agents ,Postoperative Hemorrhage ,Malignancy ,Cholangiocarcinoma ,Postoperative Complications ,medicine ,Hepatectomy ,Humans ,Surgical Wound Infection ,Registries ,ddc:610 ,Stage (cooking) ,Risk factor ,Propensity Score ,Ligation ,Intrahepatic Cholangiocarcinoma ,Survival analysis ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,business.industry ,Portal Vein ,Kirurgi ,Palliative Care ,Ascites ,Middle Aged ,medicine.disease ,Surgery ,Survival Rate ,Bile Ducts, Intrahepatic ,Treatment Outcome ,Oncology ,Bile Duct Neoplasms ,Hepatobiliary Tumors ,Propensity score matching ,Cohort ,Female ,business ,Liver Failure ,SEER Program - Abstract
Annals of surgical oncology (2020). doi:10.1245/s10434-019-08192-z, Published by Springer, Berlin [u.a.]
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- 2020
10. Choices of Therapeutic Strategies for Colorectal Liver Metastases Among Expert Liver Surgeons: A Throw of the Dice?
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Timothy M. Pawlik, Xabier de Aretxabala, Koo Jeong Kang, Ricardo Robles-Campos, Mohamed Rela, Hugo Pinto-Marques, Christian E. Oberkofler, Shimul A. Shah, Masakazu Yamamoto, Henrik Petrowsky, Christian Toso, René Adam, Kenneth K. Tanabe, Roberto Hernandez-Alejandro, Michelle L. DeOliveira, Karim Boudjema, Eduardo de Santibañes, Julia Braun, Cäcilia S. Reiner, Norihiro Kokudo, Olivier Soubrane, Orlando Jorge M Torres, Michael Linecker, Miguel Angel Mercado, Philipp Dutkowski, Yuman Fong, Povilas Ignatavicius, Hauke Lang, Ronald P. DeMatteo, Peter Lodge, Jiahong Dong, Albert C. Y. Chan, Jean Nicolas Vauthey, Ruslan Alikhanov, Giedrius Barauskas, Johnny C. Hong, Alejandro Serrablo, William C. Chapman, Bryan M. Clary, Luca Aldrighetti, Pål-Dag Line, Thomas A. Aloia, Michael I. D’Angelica, Antonio Daniele Pinna, Guido Torzilli, O. Andriani, Pierre-Alain Clavien, Ignatavicius, P., Oberkofler, C. E., Chapman, W. C., Dematteo, R. P., Clary, B. M., D'Angelica, M. I., Tanabe, K. K., Hong, J. C., Aloia, T. A., Pawlik, T. M., Hernandez-Alejandro, R., Shah, S. A., Vauthey, J. -N., Torzilli, G., Lang, H., Line, P. -D., Soubrane, O., Pinto-Marques, H., Robles-Campos, R., Boudjema, K., Lodge, P., Adam, R., Toso, C., Serrablo, A., Aldrighetti, L., Deoliveira, M. L., Dutkowski, P., Petrowsky, H., Linecker, M., Reiner, C. S., Braun, J., Alikhanov, R., Barauskas, G., Chan, A. C. Y., Dong, J., Kokudo, N., Yamamoto, M., Kang, K. J., Fong, Y., Rela, M., De Aretxabala, X., De Santibanes, E., Mercado, M. A., Andriani, O. C., Torres, O. J. M., Pinna, A. D., and Clavien, P. -A.
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Liver surgery ,Adult ,Male ,medicine.medical_specialty ,Consensus ,Decision Making ,MEDLINE ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Hepatectomy ,Humans ,Practice Patterns, Physicians' ,Therapeutic strategy ,ddc:617 ,business.industry ,General surgery ,Liver Neoplasms ,Middle Aged ,Test (assessment) ,Transplantation ,Current practice ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Female ,business ,Colorectal Neoplasms - Abstract
Objective To test the degree of agreement in selecting therapeutic options for patients suffering from colorectal liver metastasis (CRLM) among surgical experts around the globe. Summary/background Only few areas in medicine have seen so many novel therapeutic options over the past decades as for liver tumors. Significant variations may therefore exist regarding the choices of treatment, even among experts, which may confuse both the medical community and patients. Methods Ten cases of CRLM with different levels of complexity were presented to 43 expert liver surgeons from 23 countries and 4 continents. Experts were defined as experienced surgeons with academic contributions to the field of liver tumors. Experts provided information on their medical education and current practice in liver surgery and transplantation. Using an online platform, they chose their strategy in treating each case from defined multiple choices with added comments. Inter-rater agreement among experts and cases was calculated using free-marginal multirater kappa methodology. A similar, but adjusted survey was presented to 60 general surgeons from Asia, Europe, and North America to test their attitude in treating or referring complex patients to expert centers. Results Thirty-eight (88%) experts completed the evaluation. Most of them are in leading positions (92%) with a median clinical experience of 25 years. Agreement on therapeutic strategies among them was none to minimal in more than half of the cases with kappa varying from 0.00 to 0.39. Many general surgeons may not refer the complex cases to expert centers, including in Europe, where they also engage in complex liver surgeries. Conclusions Considerable inconsistencies of decision-making exist among expert surgeons when choosing a therapeutic strategy for CRLM. This might confuse both patients and referring physicians and indicate that an international high-level consensus statements and widely accepted guidelines are needed.
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- 2020
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